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Biomedical subjects

P Snell

Publications and source records attributed to P Snell.

7 recordsLinked to original sources

AIDS in Côte d'Ivoire--ten years on.

AIDS is a world-wide health problem with a profile which varies widely. Côte d'Ivoire is one of the hardest hit countries in Africa. Since the declaration of the first cases in 1985, more than 18 600 cases have been diagnosed. Many initiatives have already been undertaken in the context of the government's National Programme Against AIDS, as well as by private institutions and individuals. However, much remains to be done, against heavy odds. Hôpital Protestant de Dabou (HPD) is one of the four major centres dealing with AIDS, and has itself declared more than 3000 cases since 1987. Since 1991 it has had a team dedicated to dealing with the multiple needs of people infected with HIV and their families, and more than 2000 patients have benefited from this support. This paper reports on the experience of this programme and draws lessons for the future.

Acquired Immunodeficiency Syndrome

The effect of running on serum and red cell ferritin. A longitudinal comparison.

It is unclear whether running can affect iron stores. Results using the serum ferritin assay (SER FER) have been conflicting. Decreased red cell ferritin (RBC FER) values (< or = 4 ag/RBC) occur in iron depleted or inflammatory states. We compared the longitudinal changes of hemoglobin (Hb), SER FER, RBC FER, % saturation of total iron binding capacity (% sat TIBC), and daily dietary intake in 27 runners during a training program. These parameters were measured at days 0, 49 (range 48-52), and 115 (range 85-120). No significant changes occurred in the SER FER, % sat TIBC and Hb determinations throughout the study. Overall the RBC FER values trended down (mean values 11.7 ag/RBC to 7.7 ag/RBC; p = 0.06). Fifteen runners (56%) acquired RBC FER values in the iron deficient range (mean 6.8 ag/RBC to 2.4 ag/RBC; p < 0.05). These values differed significantly from the remaining 12 runners (mean 17.3 ag/RBC to 14.7 ag/RBC). The decline in RBC FER into the iron deficient range was primarily seen in a subset of runners who began with a RBC FER value < or = 10 ag/RBC (positive predictive value 0.79) and was independent of iron intake. We conclude that ferritin can be affected by running as recognized by the red cell ferritin assay. Moreover our results suggest that this decrease in red cell ferritin is likely a function of defective iron utilization rather than total body iron deficiency. A potential consideration is that this fall may occur as a result of repetitive running-associated injury and inflammation.

Erythrocytes

The frequency of anemia and iron deficiency in the runner.

The current consensus is that runners commonly experience a mild anemia influenced by iron deficiency. We compared hematologic parameters of 72 (35 males and 37 females) runners with 48 (27 males and 21 females) nonrunners and assessed the impact of iron supplementation. Male runners had lower hemoglobin (Hb) values than male nonrunners (14.8 vs 15.3 g.dl-1) (P less than 0.05) regardless of iron usage. Female runners had higher (P = 0.05) Hb values than female controls (13.5 vs 12.8 g.dl-1). Female runners off iron had Hbs similar to controls off iron (P = 0.30). Iron parameters (total serum iron, TSI; total iron-binding capacity, TIBC; percent saturation of the TIBC, %sat TIBC; and serum ferritin) of runners vs controls, runners vs runners (on or off iron), and nonrunners vs nonrunners (on or off iron) were comparable except 1) male runners off iron had lower (P less than 0.05) %sat TIBC values (26%) than male runners on iron (34%) and 2) female runners taking iron had ferritin values (32 ng.ml-1) similar to those of female nonrunners taking iron (39 ng.ml-1) but higher (P less than 0.05) than their counterparts off iron (15 and 15 ng.ml-1, respectively). This study concludes that running affects Hb in a variable manner and suggests that the runner's iron status is similar to that of the general population.

Adult

Assessment of the pathogenetic role of physical exercise in renal stone formation.

The effects of moderate physical exercise (performed on a bicycle ergometer to 70-75% of maximum oxygen consumption) without fluid replenishment on urinary chemistries and crystallization of kidney stone-forming substances were compared to those of rest in six normal subjects. Moderate physical exercise significantly decreased urinary pH [from 6.35 +/- 0.32 (+/-SD) to 5.79 +/- 0.33; P less than 0.05] and citrate [from 121.1 +/- 63.5 to 88.2 +/- 44.4 mg/6-h period from initiation of physical exercise; P less than 0.05 (630 +/- 331 to 459 +/- 231 mumol/6 h)], owing to induced metabolic acidosis. The total renal excretion of stone-forming constituents decreased [for example, calcium from 31.2 +/- 15.8 to 21.4 +/- 6.5 mg/6 h (0.8 +/- 0.4 to 0.5 +/- 0.2 mmol/6 h), phosphorus from 155 +/- 42 to 127 +/- 27 mg/6 h (5.01 +/- 1.4 to 4.1 +/- 0.9 mmol/6 h), and uric acid from 172 +/- 60 to 117 +/- 13 mg/6 h (1.0 +/- 0.4 to 0.7 +/- 0.1 mmol/6 h), each P less than 0.05], probably due to extracellular volume contraction (from sweating) and enhanced renal tubular reabsorption. However, the urinary concentration of stone-forming constituents significantly increased during and after moderate exercise because of the fall in urinary volume from 847 +/- 312 to 290 +/- 36 ml/6 h (P less than 0.01). Thus, urinary calcium oxalate saturation increased significantly from 2.62- to 6.68-fold saturation (P less than 0.01). The urinary undissociated uric acid concentration significantly rose [from 31.6 +/- 24.8 to 125.7 +/- 60.3 mg/L (0.19 +/- 0.15 to 0.76 +/- 0.36 mmol/L; P less than 0.01)], due to higher total uric acid concentration and reduced urinary pH. The saturation of calcium phosphate (brushite) did not change significantly, because the rise in urinary calcium concentration was compensated for by reduced phosphate dissociation (from lower urinary pH). The propensity for spontaneous precipitation of calcium oxalate was greater after exercise, as less soluble oxalate was required to elicit nucleation of calcium oxalate [58.0 +/- 21.2 to 49.0 +/- 16.4 mg/L (644 +/- 236 to 544 +/- 182 mumol/L); P less than 0.05]. The results suggest that moderate physical exercise, without increased fluid intake to compensate for excessive sweating, may cause the crystallization of uric acid and calcium oxalate in urine and may enhance the risk of the formation of renal stones composed of these salts.

Adult

Writing it down.

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Child